Bilateral testicular metastases of medullary thyroid carcinoma in an adult male with multiple endocrine neoplasia 2A syndrome: case report and review of literature

Introduction: Medullary thyroid cancer (MTC) is a rare endocrine tumor, which can be sporadic or familial, as a component of multiple endocrine neoplasia 2 (MEN2). Overall, 10% of MTC cases has already developed at presentation or will develop metastasis during follow-up. Testicular metastases are exceptional and only one case of unilateral testis' involvement by metastatic MTC has been already reported in literature. We described the first known case of asymptomatic bilateral testicular MTC metastases, discovered incidentally at testicular ultrasound performed for unrelated reasons. Case presentation: A Latin-American 32-year-old man with MEN 2A syndrome and metastatic MTC underwent andrological and urological examination due to premature ejaculation. Ultrasound imaging showed two symmetrical hypoecoic lesions involving both testis. Suspecting a bilateral testicular cancer, the patient underwent excision biopsy of both testicular lesions. Histopathology and immunoistochemical exams documented metastatic MTC of both testicular lesions. Conclusion: Beyond its rarity, testis should be considered as potential metastatic site of MTC, especially in patients with advanced disease.